Athletic Physicals 2019-20 Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Preregistration is required for athletic physicals on Tuesday, April 30th in the Runnels Catalano Gym. If you have any questions, please email the athletic trainer, Marcella Babcock, at m.babcock@runnels.org. We look forward to seeing you on Tuesday, April 30th.

Email *

Child's LAST Name *

Child's FIRST Name *

Child's Grade for the 2019 - 20 School Year *

5th grade

6th grade

7th grade

8th grade

9th grade

10th grade

11th grade

12th grade

Child's Sex *

male

female

Required: Please provide the name of the child's parent or legal guardian who will remain with the child during the screenings (required for your child to participate in any portion of the screenings). *

Contact Information: Email address and cell phone of parent/guardian: *

Arrival Times and Attire: Arrival times are staggered in an effort to minimize waiting. Rising 5th - 8th graders will be admitted at 6:00 pm. Rising 9th- 12th graders will be admitted at 6:30 pm. If you have children in both middle and high school, please arrive at the earlier time slot. Please remind your child to dress comfortably--flip flops, short sleeve or sleeveless shirt, and athletic shorts are recommended. *

My child is a rising 5th - 8th grader; we will arrive at 6:00 pm.

My child is a rising high school student; we will arrive at 6:30 pm.

Forms: Please do not bring any forms with you--we will have the forms you need here at the gym. The only forms to be completed and accepted this evening include the required LHSAA medical history evaluation form and the optional Runnels over-the-counter medication form. Please be advised that the screenings are not a substitute for continued care provided by your child's primary care physician. Since the focus this evening is solely on screenings needed for participation in athletics at Runnels School, we will not be asking the visiting or team physicians to complete outside forms for non-school programs such as overnight summer or day camps etc. Your cooperation with this is greatly appreciated. *

I understand that the pre-participation screenings by visiting health care providers are not a substitute for continued care provided by my child's primary physician.

Immunization Status *

I understand that my child's immunization status (verified by state of Louisiana immunization certificate on file at the school) must remain up to date for my child's participation in athletics.

Emergency Care Plans: If your child takes regular or emergent medication for conditions such as asthma or severe allergies, we ask that you continue to have those forms completed by your child's primary care physician. *

I understand that any care plans for regular or emergency medication must remain up to date for my child's participation in athletics.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Runnels School. Report Abuse

Forms